Improvements needed for local level providers

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

The Centers for Disease Control recommends patients contact healthcare providers for guidance on testing, and that providers seek guidance from local public health departments, but local health department websites in Texas have limited information for patients and providers.

Note that provider-level information about Zika virus is quite good at the state and national level, but at the boots-on-the-ground level it's not good.

SAN DIEGO -- Information about Zika testing for providers and patients was available on only a small portion of county health department sites in Texas, researchers reported here.

Information for providers about how to test patients for Zika was available on less than 10% of Texas' public health region Web sites, but only 3.1% of the 254 Texas county health department Web sites and 5.0% of the 39 metropolitan state health department Web sites, reported Adebayo Adesomo of UT Health San Antonio, and colleagues.

"Locally, we get a lot of complaints from providers who have no idea where to get testing, so we sent a team of medical students out to look at health department Web sites to see what information they have," said co-author Patrick Ramsey, MD, also of UT Health San Antonio at a press conference at the American College of Obstetricians and Gynecologists' annual conference. Ramsey was co-author on all of the medical students' papers from UT Health San Antonio.

Overall availability on general Zika virus information wasn't much better. Adriana Sullivan and colleagues, found that "general information" about the Zika virus was only available on 13.8% of these county public health sites, 18.1% of public health region Web sites, and about half of the metropolitan Web sites.

The students presented several poster presentations that Ramsey characterized as "eye-opening," though he added that there was more information on a state level.

A separate presentation by Jordan Gray and colleagues, found that provider-level information about Zika virus was found on 88.2% of state Web sites, though only 20.0% of U.S. territory Web sites. The most common information available was links to CDC publications (80.8%) and local cases and Zika testing information (76.9% each).

"We're doing a great job at state and national level, but at the boots-on-the-ground level, it's not good," Ramsey said.

On Friday, the CDC updated their guidance for providers about how to interpret Zika testing for asymptomatic patients who live in or "frequently travel" to areas with a CDC Zika travel notice. These include:

Pregnant women and their partners should be tested via nucleic acid test (NAT) at any point during pregnancy if the woman develops symptoms

Women should be tested via NAT least once during each trimester of pregnancy

Clinicians should consider testing specimens obtained during amniocentesis for Zika if amniocentesis is performed for other reasons.

"I would guess if we're expanding testing, the cases would go up even if nothing changes," Ramsey said. "So, we're going to see huge rises in number of cases because we're testing a lot more people, so that's going to raise the panic level even though nothing may have changed in the background."

In a separate study, Adriana Ramos, of the L.A. County Department of Public Health in Los Angeles reported that there were many opportunities for preconception counseling for Zika -- mainly because so few patients were using effective forms of contraception. Over a third of patients said they used condoms, but 28% said they were not using any contraception.

Co-author Diana Ramos, MD, also of L.A. County Department of Public Health, said that L.A. county not only has the highest number of Zika cases in the state, but also is responsible for 1 in 30 births in the U.S.

She addressed the timeliness of the research, saying that they are "anticipating a heavy mosquito season because of the wet weather" in southern California.

But Ramos emphasized that the one thing she thinks providers are "overlooking" is not asking about the travel activities of patients' partners.

"A lot of partners are traveling and the spouse stays at home. I think we forget to ask is your partner traveling or did your partner travel. But it's a matter of time and I don't think providers are screening for it," she told MedPage Today.

Ramsey added that most ob/gyns won't be able to test the partner, "which is going to be another barrier," he said.

Ramsey, Adesomo, Sullivan and Gray disclosed no conflicts of interest.

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